Exploring the barriers to the introduction of a best practice nutrition and dietetics service model in rural areas

This body of research explores the barriers that exist to the introduction of best practice models for dietetics services in rural areas of Australia. Best practice in this thesis refers to workforce staffing and organisational best practice, rather than clinical best practice. For the purpose of this thesis a best practice dietetic service has been defined as a timely, accessible, up-to-date nutrition and dietetic service that is effective in meeting the identified needs of the community based on a quality health service definition (Halton 2005). There is no known previous research that has investigated the elements of a best practice dietetics staffing model and the factors that support or inhibit the development of a best practice dietetic service model in rural areas. A review of the literature was conducted to determine the potential features of a best practice dietetic service for rural areas and the factors that are known to affect the development of a best practice service. A theoretical model of best practice dietetic services for rural areas was tested using a series of case studies. An exploratory sequential mixed methods approach has been used in six case study sites to investigate the barriers to best practice using rural sites in northern New South Wales (NSW), Australia as the setting. The mixed method multiple case study investigated the dietetics workforce characteristics and development in the study sites. Best practice dietetic service delivery was tested with cancer patients using the implementation and evaluation of best practice dietetic clinical guidelines in a rural setting. Key findings from this research include: retention issues related to a lack of management support, limited career pathways and professional isolation. Key drivers for the creation of dietetics positions included the actions of champions and the support of management. The main barriers to the creation of positions included a general lack of funds and competing priorities. The outcomes of this research are important for future workforce planning for dietitians in rural areas.